Celiac Plexus Block
It is not surprising that almost all cancer patients report that the pain is the most distressing aspect of the condition. Indeed, patients suffering from pancreatic cancer face the most severe and typically unremitting forms of pain. Treatment of this pain can be challenging for physicians and frustrating for patients. This type of pain can also be unresponsive to many types of treatment. One of the most effective treatments available for managing this pain is the celiac plexus block.
The celiac plexus block is a non-surgical treatment option for managing chronic and refractory pain located in the abdomen. There is a bundle of nerves that lies close to the celiac artery underneath the stomach, but in front of the diaphragm. This bundle of nerves can contain between one to five larger ganglia that function to innervate the liver, stomach, gallbladder, pancreas, kidneys, spleen, intestines, adrenal glands, and blood vessels. Thus, the celiac plexus block effectively treats abdominal pain by inhibiting the transfer of information between these areas and the spinal cord and brain.
What is a Celiac Plexus Block?
How a Celiac Plexus Block is Performed
The procedure for a celiac plexus block can be done in several ways. In general, many prefer this treatment option as it does not require surgery, is minimally invasive, and typically is conducted with only a local anesthetic. The celiac plexus block can be done on an outpatient basis.
The most commonly used method for performing a celiac plexus block requires that the patient lay down flat on their stomach. The performing physician will anaesthetize the area using a topical anesthetic applied to the surface of the skin in two different areas on the back. One area is the location where an X-ray device is inserted that the physician will use to assist in guiding the injection needle to the proper location. The second area is where the injection needle is inserted. In some cases, the physician may use contrast dye in order to confirm correct placement of the injection needle. Once the physician is certain that the needle is in the correct position, the anesthetic is injected.
For a neurolytic celiac plexus block, many physicians will also inject alcohol in addition to the anesthetic medication. The purpose of the alcohol is to destroy the tissue of the nerves that transmit pain information from the abdomen to the spinal cord and brain, also known as the celiac ganglia, which temporarily impairs their function.
In most cases, the celiac plexus block takes less than 30 minutes to perform. Some patients may request an intravenous sedation medication in order to make the procedure more comfortable. Should this occur, the patient’s vital signs are monitored closely, including their body temperature, pulse rate, and blood pressure. Once the procedure is complete, patients are transported to a recovery room where they are monitored for any adverse reactions. Patients can expect to spend anywhere from two to four hours in recovery before they are discharged by their physician.
A proportion of celiac plexus block patients will report an almost immediate reduction of pain, though many patients do not experience pain relief for six to 24 hours. For patients who have experienced reductions in their pain, though still experience some symptoms, it may be recommended that they return for repeat injections. Celiac plexus block injections are safe enough to be administered repeatedly. Thus, it is recommended that patients receive additional injections until they no longer report pain.
Conditions Related to ...
Previous studies have provided ample evidence to support the use of the celiac plexus block in reducing to relieving severe and refractory pain associated with neuropathic conditions. The celiac plexus block targets pain within the abdomen in particular. Thus, patients suffering from malignancies of the stomach, gallbladder, liver, or large colon are likely to expect the most benefit from receiving a celiac plexus block. In particular, patients suffering from pancreatic cancer have been documented as responding favorably to the procedure.
Neurolytic celiac plexus blocks are not as common. This procedure, though, is also reserved for the treatment of pain and discomfort associated with malignancies of the upper abdomen. The most appropriate patient cases are those who have undergone previous failed treatment trials.
Conclusions
The celiac plexus block is a procedure used to treat severe and refractory forms of chronic pain within the abdominal region. The target of this treatment is to inhibit the function of the celiac ganglia, which is responsible for transmitting pain information from the peripheral nerves to the spinal cord and brain.
The procedure is non-surgical and minimally invasive. It is typically performed on an outpatient basis.
There are relatively few risks involved with a celiac plexus block and most patients report improvements in pain almost immediately. Patients who do not achieve complete pain relief with the first injection may return for follow-up injections until they are completely pain free. Recovery from the procedure can take between two to four hours and patients are typically discharged the same day. Patients are encouraged to speak with their doctor about the risks and benefits of a celiac plexus block for managing their symptoms of pain.
References
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Bahn BM, Erdek MA. Celiac Plexus Block and Neurolysis for Pancreatic Cancer. Curr Pain Headache Rep.2013;17;310.
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Bektas M, Atiq M, Bhutani MS. First report of celiac plexus block for refractory abdominal pain secondary to peripancreatic colon cancer metastasis. Gastrointest Endosec. 2012;76(3):692-3.
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McGreevy K, Hurley RW, Erdek MA, Aner MM, Li S, Cohen SP. The effectiveness of repeat celiac plexus neurolysis for pancreatic cancer: A pilot study. Pain Pract. 2013;13(2):89-95.
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Yan BM, Myers RP. Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol. 2007;102(2):430-8.
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Zhong W, Yu Z, Zeng JX, Lin Y, Yu T, Min XH, Yuan YH, Chen QK. Celiac plexus block for treatment of pain associated with pancreatic cancer: A meta-analysis. Pain Pract. May 2013; [Epub ahead of print].
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Zou XP, Chen SY, Lv Y, Li W, Zhang XQ. Endoscopic ultrasound-guided celiac plexus neurolysis for pain management in patients with pancreatic carcinoma reasons to fight a losing battle. Pancreas. 2012;41(4):655-7.
Patients receiving celiac plexus block injections can expect to experience relief from even severe and refractory forms of pain. Neurolytic celiac plexus block patients generally report around two months of pain relief. Some common side effects reported along with this procedure include transient diarrhea and hypotension.
As with most medical procedures, there is some risk associated with celiac plexus blocks though they are generally mild. In most cases, adverse effects are related to misplacement of the injection needle, puncturing a nearby organ, or puncturing a neighboring blood vessel. Other adverse reactions include bleeding, allergic reaction, infection, pneumothorax (i.e., collapsed lung), nerve damage, and paralysis.